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N <br />Rug 15 2008 2:39PM 0 <br />9253-2109 P.1 <br />DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wv w.sjgov.o /e <br />V k <br />PUBLIC RECORDS RELEASE APPLICATI N <br />TENTATIVE" APPOINTMENT DATE: • Z i .'l �! Time: <br />(Please allow 10 business days from date of appli on submittal-'Temtemve only - must be confirmed) <br />171 CHECK BOX TO EXPEDITE REQUEST -$106 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS �DAYS <br />SIGNATURE OF APPLICANT S,/jam% DATE V- <br />Electronic information: <br />❑ListElMap- Description: APr4 'S <br />Z 6' 3.00 6'3.00 <br />FILE ADDRESS <br />EHD USE ONLY <br />street III <br />Street Nam�ev city <br />�1 Z %A� <br />Unit1 <br />t• <br />UG.� Gd !� • Via. <br />2. <br />❑ <br />Unit2 <br />3. <br />Unit 3 <br />4, <br />5. <br />unit 4 <br />s. <br />7. <br />❑ <br />unit <br />8. <br />❑ <br />unit 6 <br />% <br />4\ <br />Specific Date Range of Information Requested: From (!� -7 ff to <br />���[[[ I7 ENVIRONMENTAL HEALTH DEPARTMENT FILES ,d IP�kr <br />UNDERGROUND TANK(USTI CLEANUP SITE (LOP) 0 HOUSING ABATEMENT CISOLID WASTE FACILrYIVEHIC4LE <br />tl <br />OTHER CLEANUP SITE (NON -LOP) ❑FOOD FACILITY WASTE TIRE �/l pp <br />NDERGROUND TANK (MONITORING/REMOVAL)A 4 [3DOG KENNEL DAIRY <br />�HAa 2ARDOUS WASTE GENERATORM CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT b <br />K <br />❑ TIERED PERMITTED FACIUTY M MOTELIHOTEL 0 PUMPERTRUCKIYARD/CHEM TOILETS <br />0 TATTOOIBOOY PIERCING ❑ POOL(SPA M LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 9:00 AM6:00PM - EXCLUDING HOLIDAY& <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (208)464-0138 or mall to the address indicated above. Address <br />ranges will not be accepted —for additional assistance with Nle addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant If any END files exist An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br />submitted when the file is available. <br />4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant <br />Future file reviews by the same applicant may require a $105 deposit prior to review. <br />EHD USE ONLY <br />'e? <br />